Your Contact Information

First Name *

Last Name *

Phone Number *

Email Address (please list your Northeastern Email) *

Street Address *

Address Line 2

City *

State *

Zip Code *

Terms and conditions of use

I understand that 1- Fire code prohibits use of candles, incense etc. (religious needs may be discussed w/ the Director of The Center for Spirituality, Dialogue, and Service ); 2- I am responsible for leaving the requested areas clean and in the way I found them; 3- Funds/money may not be collected in the areas except when given express permission by the Director of The Center for Spirituality, Dialogue, and Service; 4- This request is not confirmed until I receive written notification from The Center for Spirituality, Dialogue, and Service (allow two weeks); 5- The Center for Spirituality, Dialogue, and Service reserves the right, in rare instances, to reschedule or cancel an event; and 6- The Center for Spirituality, Dialogue, and Service reserves the right to refuse future use, should the conditions above not be adhered to.” *

YES

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